Employee Info

  • Employee Name:

  • Employee Title:

  • Employee Work Location:

Corporate H&S

  • Do you know where to find the H&S Policy?

  • Do you know what the H&S Program is?

  • Do you know where the H&S Program is located?

  • Is safety important to you?

  • What do you do to ensure you and your co-workers are working safely?

  • Is safety important to your supervisor?

  • Are you aware of the Safety Commitment Document signed by the Executive and IBEW? What does this mean to you?


  • If you were unable to keep your mind on your task (high risk jobs) and feel you might make an error, would you feel comfortable speaking up?

  • If you are a manager/ supervisor/ lead/ foreman: what would your response be if an employee said he / she couldn't do his high-risk work today because he/she was not focused on the job?

JHSC and Safety Meetings

  • Do you know who your representatives are on the JHSC?

  • Do you review the monthly minutes?

  • Do you attend the monthly Safety (Loss Control) Meetings?

  • Do you find the Safety (Loss Control) Meetings beneficial? If no, what could make it better?


  • Have you been trained on the proper use of PPE?

  • Do you know how to do a proper inspection of your PPE?

  • Would you be comfortable to speak up if your co-worker wasn't wearing the proper PPE?

Fire safety

  • Can you tell me how to use a fire extinguisher?

  • Are you aware of the emergency evacuation procedure?

Emergency response

  • Do you know how, and to whom you would report an emergency?

  • Could you tell me what you would do if anyone was injured?

  • Tell me if you or anyone you work with has experienced an injury?

  • Do you understand the incident reporting process?


  • Do you know where the MSDS location is?

Tailboard Conference

  • When do you complete a Tailboard Conference?

  • Do you receive feedback on the quality of the Tailboards?


  • Do you have all the training you need to do your job?

  • Does your supervisor review your training compliance with you?

  • If you are a supervisor / manager, do you receive training reports for your department?

Employee & Family Assistance Program (In-Confidence Program)

  • Are you aware of the New EFAP and where to find the information?

Additional Comments:

  • In your opinion .... What is going well? What should be improved?

  • .

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